639 / Impact of implementation of the Surviving Sepsis Campaign Guidelines on mortality in an Intensive Care Unit

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Preventing sepsis
Infection control / Prevention of surgical site infections There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
The Surviving Sepsis Campaign (SSC) Guidelines give a group of interventions (“sepsis bundles“) expected to improve the outcome of patients with severe sepsis. The aim of this study was to evaluate the impact of the implementation of the SSC Guidelines on the mortality in our Intensive Care Unit (ICU).
Description of the Patient Safety Practice
 
Prospective, observational study. During one year period (January 08-January 09) the sepsis bundles were applied to each patient with severe sepsis- septic shock and they were followed up until discharge. We considered as “time O“ (the time of delay of the implementation of the sepsis bundles) the time of admission of the patients in the ICU. For each severe septic patient the following data was registered: time delay, APACHE II and SOFA scores at ICU admission, diagnosis, the rate of compliance with the resucitation and management bundles, microbiological data, evolution of levels of serum lactate, empiric antibiotic therapy and if it was appropriated with the antibiogram, length of stay and mortality in ICU.
The application of guidelines impact on mortality was compared with historical data years before implementation in our ICU (46,3%) and Spanish ICU (48,2%) (2).
RESULTS
A total of 61 severe septic patients were included in the study. 7 (11,5%) patients had severe sepsis and 54 (88,5%) septic shock. The median age was 70 years. The mean APACHE II was 21,7 ( ±8 ) and SOFA was 8,5 (±4,3). The main sources of infection were abdomen (59%), lungs (21%), urinary tract (11,7%) and soft tissues (3,27%). The most common clinical diagnosis related to an episode of severe sepsis was peritonitis (59%). A microbiological diagnosis of the infection was reached in 75,4% and the infections were mostly caused by Gram- bacilli. Once the antibiogram was obtained, the initial treatment was considered appropriate in 96,7% patients. The rate of compliance with sepsis bundles was 100%. The length of ICU stay was 15,3 days. Mortality was 21,3%. The implementation of the sepsis bundles decreased ICU mortality significantly (48,2% before implementation vs. 21,3% after implementation).
Non survivors were older (median age 77±4,8), had higher APACHE II (mean 29,3±9 ) and SOFA (mean 14±3,6), 100% had septic shock, 61,5% had negative cultures and an increased on the levels of serum lactate in 24h. Age, APACHE II and SOFA scores and the increased on the levels of the serum lactate were useful tools to predict mortality.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
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There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
Int Care Med 09; 35(S1):S34
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: concepcion valdovinos mahave
Country: SPAIN
Organisation: Hospital Obispo Polanco, Aragon
E-mail: mcvaldovinos@salud.aragon.es
Phone: 667966260
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